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Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study

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Abstract

Vascular mechanics assessed with two-dimensional speckle tracking echocardiography (2D-STE) could be used as a new imaging surrogate of vascular stiffening. The CHA2DS2-VASc score is considered accurate as an estimate of stroke risk in non-valvular AF, although many potential stroke risk factors have not been included in this scoring method. The purpose of this research is to study the feasibility of evaluating vascular mechanics at the descending aorta in non-valvular AF patients using transesophageal 2D-STE and to analyze the association between descending aortic mechanics and stroke. We prospectively recruited a group of 44 patients referred for a transesophageal echocardiogram (TEE) in the context of cardioversion for non-valvular AF. A short-axis view of the descending aorta, one to two centimeters after the aortic arch was selected for the vascular mechanics assessment with the 2D-STE methodology. The vascular mechanics parameters analyzed were circumferential aortic strain (CAS) and early circumferential aortic strain rate (CASR). A clinical assessment was performed with focus on the past stroke history and the CHA2DS2-VASc score. The mean age of our cohort was 65 ± 13 years and 75% were men; AF was known for 2.8 ± 2.5 years and it was considered paroxystic in 41% of cases. Waveforms adequate for measuring 2D-STE were present in 85% of the 264 descending aortic wall segments. The mean CAS was 3.5 ± 1.2% and the mean CASR was 0.7 ± 0.3 s−1. The inter- and intra-observer variability for aortic mechanics was considered adequate. The median CHA2DS2VASc score was 2 (2–3). As the score increased we noted that both the CAS (r = −0.38, P = 0.01) and the CASR (r = −0.42, P < 0.01) decreased. Over 16% of the AF patients had a past history of stroke. These patients had lower values of both descending aortic strain [2.2 (1.8–2.6) vs. 3.9 (3.3–4.9)%, P < 0.01] and strain rate [0.4 (0.3–0.4) vs. 0.7 (0.6–1.1) s−1, P < 0.01]. CAS remained independently associated with a past history of stroke after adjustment for the CHA2DS2VASc score. Our data showed that non-valvular AF patients with a past history of stroke had lower values of aortic mechanics assessed with transesophageal 2D-STE.

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Abbreviations

2D-STE:

Two-dimensional speckle tracking echocardiography

β1 :

Aortic stiffness index

ε:

Strain

AF:

Atrial fibrillation

BSA:

Body surface area

CAS:

Circumferential aortic strain

CASR:

Circumferential aortic strain rate

CHA2DS2-VASc score:

C-congestive heart failure; H-hipertension; A2-age >75; S2-stroke; V-vascular disease; A-age 65–75; Sc-sex category

CoV:

Coefficient of variation

EHRA:

European heart rhythm association

HF:

Heart failure

LA:

Left atrium

LAA:

Left atrial appendage

LAVI:

Lef atrial volume index

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

NYHA:

New York heart association

PWV:

Pulse wave velocity

ROI:

Region of interest

SR:

Strain rate

TEE:

Transesophageal echocardiography

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Authors and Affiliations

  1. Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo, Coimbra, Portugal

    Rogério Teixeira, Paulo Dinis, Maria José Santos, Ana Botelho, Nuno Quintal & Lino Gonçalves

  2. Faculdade de Medicina Universidade de Coimbra, Coimbra, Portugal

    Rogério Teixeira & Lino Gonçalves

  3. Lister Hospital, Stevenage, UK

    Ricardo Monteiro

  4. Serviço de Cardiologia, Hospital da Luz, Lisboa, Portugal

    Nuno Cardim

Authors
  1. Rogério Teixeira
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  2. Ricardo Monteiro
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  3. Paulo Dinis
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  4. Maria José Santos
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Correspondence to Rogério Teixeira.

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Teixeira, R., Monteiro, R., Dinis, P. et al. Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study. Int J Cardiovasc Imaging 33, 509–519 (2017). https://doi.org/10.1007/s10554-016-1028-4

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  • DOI: https://doi.org/10.1007/s10554-016-1028-4

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